Female global health leadership: data-driven approaches to close the gender gap

Stakeholder mapping for a complex and diverse population: methodology for identifying leaders across sub-Saharan Africa

BACKGROUND

Stakeholder-related methodologies for low- and middle-income countries (LMICs) have primarily focused on stakeholder engagement or identification of specific, well-defined populations. Current stakeholder mapping research methods do not provide sufficient sampling processes for defining and implementing a sampling frame for poorly defined populations. In this paper we develop a unique stakeholder mapping methodology and apply it to the Transforming health: The role and impact of women's leadership in the health sector (THRIVE) study, aimed at generating evidence to support investment in women's leadership in global health decision-making in reproductive, maternal, newborn, child, and adolescent health, and nutrition (RMNCAH-N) and immunization across sub-Saharan Africa (SSA). Though current literature has examined challenges women have faced to reach leadership roles, there are no methods for systematically identifying women leaders, and leaders in RMNCAH-N and immunization have not been uniformly well-defined or systematically documented. Consequently, understanding the impact of women's leadership on health and healthcare policies is lacking.

RESULTS

We developed a stakeholder mapping methodology to ensure accurate identification and representation of leaders in RMNCAH-N and immunization in Sub-Saharan Africa who could serve as a "sampling universe" for further investigation into the impact of women leaders. We began by defining what constituted a "leader" and "leader-adjacent" individual. Using a matrix, we refined the target sample of stakeholders and created uniform inclusion criteria. Stakeholder mapping was guided by the following strategic steps for each SSA country: screen government webpages; contact UN/multilateral agencies; conduct a systematic Google and social media search; identify relevant academic and grey literature; contact professional and personal connections in SSA; cross-check leads against a pre-defined matrix of stakeholder levels; and in-country validation. Inputs were collated into a shared Excel sheet. At the end of the stakeholder mapping exercise, we had systematically identified 3,901 leads. On average, 81 stakeholders were identified for each country. Approximately 38% (n = 1353) of the identified individual stakeholders were women.

CONCLUSIONS

This paper's focus on creating a sampling universe of women leaders in RMNCAH-N and immunization in SSA fills a gap in current operational and implementation research. The insights derived from the adaptation and application of this methodology highlight the value of a structured approach to capturing the complexities of stakeholder and leadership dynamics in global health, particularly when applied to systematically map health topics or disciplines that lack databases or public records.

Gender and healthcare leadership: Addressing critical knowledge gaps by explicitly considering the gendered concept of care

This scoping review of gender and healthcare leadership synthesized the barriers and facilitators at multiple levels employing a framework that integrates a specific focus on the concept of care. The 71 sources identified focus predominantly on barriers to women's leadership at the individual and team level and, to a lesser extent, at the organizational and system level. Facilitators tend to be presented as recommended actions than evaluated interventions. Healthcare leadership tends to ignore the gendered context of care elevating leaders who are least likely to provide such care. Where personal caregiving circumstances are considered, they are individualized, reflecting the literature in general. More critical analysis is needed to focus on women's experiences and how their gender can predetermine their success in achieving and being in leadership positions. Healthcare leadership researchers are encouraged to include gender and care-focused analyses and interventions to address the under-representation of women in healthcare leadership.

A roadmap for surgeon leaders in improving gender equity: educational strategies, implementation, and evaluative methods

BACKGROUND

Gender diversity is lacking in the orthopedic workforce, and patient outcomes are known to be negatively affected when gender inequity exists. Following an unpublished needs assessment, we sought to evaluate participants' proposed solutions to gender inequity faced by female orthopedic surgeons in Canada and to translate the range of solutions into a medical education model.

METHODS

Open-text responses from a gender-bias survey of Canadian orthopedic surgeons who identified as women were analyzed qualitatively by 2 experts. The questions covered the domain of changes required to improve the work environment. We used the latter 2 steps of Kern's educational framework as a lens to interpret the data and generate solutions.

RESULTS

A total of 330 eligible surgeons were approached, and 220 (67.0%) completed the survey. Respondents provided more than 14 000 words of text for analysis. Using the themes of the unpublished needs assessment, we defined broad goals and specific objectives, including raising awareness, establishing an equitable playing field, drawing attention to male privilege, developing effective mentorship, eliminating harassment, and unburdening the second shift. We present solutions via educational strategies and evaluative methods based on Kern's framework.

CONCLUSION

We offer a road map for improving gender diversity in orthopedic surgery, based on survey results from Canadian women in orthopedic surgery, analyzed using a gender bias framework and an educational conceptual framework. We hope that this work will improve the surgical profession and patient care.

A scoping review on the impact of women's global leadership: evidence to inform health leadership

INTRODUCTION

The documented benefits of gender parity in leadership are emerging-women leaders have been shown to have a positive impact on maternal and health care policies, strengthen health facilities, and reduce health inequalities. More research is needed, however, to document their impact on global health. We go beyond the well-documented barriers that uphold the lack of gender parity by identifying areas where women leaders are making an impact to inform investment, programming, and policy.

METHODS

We conducted a scoping review of peer-reviewed literature, following Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, to map evidence on the impact of women's leadership in organisations in low- and middle-income countries. As many leadership outcomes are cross-disciplinary, outcomes were explored across sectors with particular attention paid to the relevance of these outcomes for global health.

RESULTS

137 articles were included in the review. Studies found women leaders' positive influence on six areas of impact: (1) financial performance, risk, and stability, (2) innovation, (3) engagement with ethical initiatives, (4) health, (5) organisational culture and climate outcomes, and (6) influence on other women's careers and aspirations. Articles reporting mixed results focused on multiple indicators and still largely pointed to positive results, particularly when modified by other factors including increased education, increased experience, and opportunities to work with other women across the organisation. In all sectors, across leadership roles, and across geographies, women's leadership can produce positive results. Women leaders' success, however, cannot be separated from the contexts in which they work, and unsupportive environments can affect the extent to which women leaders can have an impact.

CONCLUSION

Increased and sustained investment in women's leadership within the health sector can lead to improved outcomes for organisations and their clients. Such investments must not only target individual women, but also seek to foster organisational cultures that promote and retain women leaders and support their independent decision-making.

Escaping the midway trap: A mixed method study highlighting roadblocks and coping mechanisms of female researchers in Cameroon

Across the world, women make most of the health workforce, but remain underrepresented in academia. This is even worst in Sub-Saharan Africa where women are the least represented as first and last authors in publications, especially in francophone countries. However, there is a lack of data on the reason explaining this inequity. Therefore, we sought to describe challenges which hinder the growth of Cameroonian female researchers and conducted a mixed method study over one year from January 2020 to December 2020. We included Cameroonian female researchers in health. For the quantitative arm, data was collected through an online google questionnaire. In-depth interviews were organized for the qualitative arm. Data was analyzed using python software version 21 for the quantitative arm and content analysis was performed for qualitative data. A total of 119 participants were included in this study. Most participants were aged between 25 and 35 years (72%) and they were Christians (94%). The majority had at least a PhD degree (29.6%) and they came from the West region of Cameroon (34.2%) the Northern regions were grossly underrepresented. More than half of our participants faced issues with balancing career, work, and academia and this is linked to culture. Socioeconomic, sociocultural, institutional, and environmental roadblocks hinder the progress and research productivity of most female researchers. The burden of unpaid maternity leaves, and sexual harassment remains high for most women. The use of English language as lingua Franca is perceived as another barrier for one on two women. However, there are coping strategies adopted by female scientists including the development of soft skills such as self-confidence, determination, and hard work. Extrinsic factors such as global policy, international partnerships, workshops, mentorship, and networking are also supporting women in global health. Gender-based interventions are critical to support women in escaping the midway trap.

The Glass Ceiling in Global Health: Perspectives of Female and Male Anesthesiologists

BACKGROUND

Gender equity is essential for improving health outcomes globally. Despite comprising 75% of the global health workforce and dominating academic global health programs, women remain underrepresented in leadership positions in global health organizations. Our study aimed to identify potential gender differences in the beliefs and attitudes regarding barriers that women anesthesiologists encounter in pursuing careers and leadership roles in global health and to identify recommendations for improving gender equity in global health.

METHODS

We conducted a cross-sectional online survey focusing on career leadership opportunities and challenges uniquely faced by women clinicians in global health. We obtained permission from the World Federation of Societies of Anaesthesiologists to distribute our questionnaire to their leadership committee members during 2 months (May-July 2022).

RESULTS

The questionnaire was distributed to 164 study participants with 67 individuals (44.8% female) based in 38 different countries completing the survey (response rate 40.9%). Overall, 47.8% of the participants aspired to a leadership position in global health and 58.2% agreed women face unique barriers to global health leadership (70.0% of women compared to 48.6% of men; P = .081). Female gender (odds ratio [OR], 19.22, P = .004) and divorced marital status (OR, 746.26, P = .004) were positively associated and African ethnicity (OR, 0.002, P = .017) was negatively associated with the perception of gender bias in their career growth. The main challenges included balancing work and family responsibilities, lack of female mentors or role models, gender-based discrimination, and limited opportunities for career advancement. Men acknowledged these challenges but reported personally experiencing them to a lesser extent, particularly concerning lack of opportunities (P = .005), inadequate pay (P = .000), and lack of training (P = .000).

CONCLUSIONS

Gender disparities exist in the pursuit of global health careers. This study underscored that more women than men perceive barriers in pursuing leadership roles in global health and that men generally encounter these obstacles to a lesser extent. Female representation in leadership positions could be supported through evidence-informed policies that promote work-life balance, improve mentorship, offer equal opportunities for career advancement and adequate pay, and combat gender-based discrimination.

The Female Global Scholars Program: A mixed-methods evaluation of a novel intervention to promote the retention and advancement of women in global health research

Fewer than 25% of global health leadership positions worldwide are held by women, adversely impacting women's health and widening gendered health disparities. The Female Global Scholars (FGS) Program, established in 2018 at Weill Cornell Medicine, is a two-year hybrid training and peer-mentorship program that promotes the retention and advancement of early-career female investigators conducting health research in low- and middle-income countries (LMICs). The purpose of this study is to determine the impact of the FGS Program on individual career advancement, academic productivity, and research self-efficacy. This mixed-methods study followed an explanatory sequential design. Participants completed an electronic survey collecting information on demographics, academic milestones, and research skill competency. Survey data were descriptively analyzed using R (Version 1.4.1106). In-depth interviews explored perceptions of the impact of the FGS Program on career development. The authors independently reviewed and thematically analyzed de-identified transcripts using NVivo (Version 13). In June 2022, twelve participants completed the survey. The median age was 40 years; 90% carried an MD, PhD, or other post-graduate degree. Since joining the FGS Program, respondents achieved a combined total of eight awarded grants, five academic promotions, 12 oral scientific presentations and 35 first-author peer-reviewed publications. Thematic analysis identified four overarching themes: gaining confidence through mimicry; improved self-efficacy to address gendered challenges; real-world application of scientific and career development skills; and building multi-disciplinary communities in a protected female-only space. We demonstrate that this low-cost training and mentorship program successfully addresses critical barriers that impede women's advancement in global health research. Our data may inform the adaptation of this initiative across other academic institutions.

Looking beyond workforce parity: addressing gender inequity in pathology

While women pathologists have made up over one-third of pathologists in the Australian workforce for over 15 years and at least 50% since 2019, they are under-represented in senior leadership roles, scientific publications, grant recipients, editorial boards, key presentations, and professional awards. This is not unique to pathology and is seen in the broader medical and academic community. Barriers to gender equity and equality in pathology, medicine and academia include gender stereotypes, gender-based discrimination, structural and organisational barriers as well as broader social and cultural barriers. A diverse leadership reflective of the whole professional body and the broader community is important for optimal health outcomes. It is the responsibility and moral duty of individuals and organisations to address any gender disparities, inequities, and inequalities by monitoring, identifying, and acting on gender biases and systemic barriers that hinder appropriate levels of representation by women.

Comparing barriers and enablers of women's health leadership in India with East Africa and North America

Background

Women are estimated to hold between 70 and 75% of global health positions worldwide yet persistent inequities in power and leadership remain. There is little information on specific enablers and barriers that women working in public health face in India and how those compare with other regions.

Methods

We collected and analyzed information from women working in public health in India and East Africa (Kenya, Rwanda, and Uganda) and in global health (Canada and United States), to understand and document the specific enablers and barriers women face in India, compared with other regions.

Findings

Several universal themes emerged around factors enabling (mentors, professional networks, leadership based in empathy and team building) or impeding (obvert bias and family responsibilities) women across all contexts. Within this, there are nuances in how women's leadership growth factors and obstacles play out in India differently than in other contexts.

Interpretation

There are important similarities in the enablers and barriers faced by women in India and other geographies and important ways these differs in for women in India. By designing programs and policies at institutional levels to address these factors, we can create a professional ecosystem that works for women in health and beyond.

Funding

This research was funded by WomenLift Health, which is funded by the Bill and Melinda Gates Foundation. Representatives from WomenLift Health, listed as authors, participated in the conceptualization of the research to define objectives and core questions, provided commentary and revision to improve the manuscript, and supervised the progress of the research.

"Mobilizing our leaders": A multi-country qualitative study to increase the representation of women in global health leadership

Women play an essential role in health care delivery, and it is vital that they have equal representation in health leadership for equity, innovation, and the strengthening of health systems globally. Yet women remain vastly underrepresented in global health leadership positions, providing a clear example of the deeply rooted power imbalances that are central to the calls to decolonize global health. We conducted a multi-country study in Haiti, Tanzania, India, and the USA to examine gender-based challenges to career advancement for women in the global health workforce. Quantitative data on the type and prevalence of gender-based challenges has been previously reported. In this study, we analyze qualitative data collected through focus group discussions and in-depth interviews to understand women's experiences of gender-based obstacles to career advancement, their perceptions of underlying drivers, and perspectives on effective solutions. Guided by an adaptation of the Social Action Theory, we conducted focus group discussions and in-depth interviews with women at 4 major academic centers for clinical care and research in Haiti, India, Tanzania, and the United States. In total, 85 women participated in focus groups and 15 also participated in in-depth interviews. Discussions and interviews were conducted in the local language, by an experienced local facilitator unaffiliated with the participating institution, between 2017 and 2018. Discussions were recorded, transcribed, and translated. Data were analyzed by interpretive phenomenological methods for emergent themes. Three transcendent themes on gender-based challenges were identified: 1) cultural power imbalance, referring to the prevailing norms and engrained assumptions that women are less capable than men and that women's primary responsibility should be to their families; 2) institutional power imbalance, referring to the systematic gender bias upheld by existing leadership and power structures, and ranging from exclusion from career development opportunities to sexual harassment and assault; and 3) restricted agency, referring to women's limited ability to change their circumstances because of unequal cultural and institutional structures. Participants also described local, actionable solutions to address these barriers. These included: 1) formal reporting systems for sexual harassment and assault; 2) peer support and mentorship; and 3) accessible leadership training and mandatory gender equity training. Participants proposed feasible strategies to address gender-based challenges that could improve women's retention in health careers and foster their rise to leadership. Increasing the representation of women in global health leadership positions responds directly to efforts to decolonize global health and is integral to strengthening health systems and improving health outcomes for women and children worldwide.

Experiences of Canadian Female Orthopaedic Surgeons in the Workplace: Defining the Barriers to Gender Equity

BACKGROUND

Only 13.6% of orthopaedic surgeons in Canada are women, even though there is nothing inherent to the practice of orthopaedic surgery that favors men over women. Clearly, there is a need to identify, define, and measure the barriers faced by women in orthopaedic surgery.

METHODS

An electronic survey was distributed to 330 female-identifying Canadian orthopaedic surgeons and trainees and included the validated Gender Bias Scale (GBS) and questions about career burnout. The barriers for women in Canadian orthopaedics were identified using the GBS. The relationships between the GBS and burnout were investigated. Open-text questions explored the barriers perceived by female orthopaedic surgeons.

RESULTS

The survey was completed by 220 female orthopaedic surgeons and trainees (66.7%). Five barriers to gender equity were identified from the GBS: Constrained Communication, Unequal Standards, Male Culture, Lack of Mentoring, and Workplace Harassment. Career burnout correlated with the GBS domains of Male Privilege (r = 0.215; p < 0.01), Disproportionate Constraints (r = 0.152; p < 0.05), and Devaluation (r = 0.166; p < 0.05). Five main themes emerged from the open-text responses, of which 4 linked closely to the barriers identified in the GBS. Work-life integration was also identified qualitatively as a theme, most notably the difficulty of balancing disproportionate parental and childcare responsibilities alongside career aspirations.

CONCLUSIONS

In this study, 5 barriers to workplace equity for Canadian female orthopaedic surgeons were identified using the validated GBS and substantiated with qualitative assessment using a mixed-methods approach. Awareness of these barriers is a necessary step toward dismantling them and changing the prevailing culture to be fair and equitable for all.

CLINICAL RELEVANCE

A just and equitable orthopaedic profession is imperative to have healthy and thriving surgeons who are able to provide optimal patient care.

Does global health governance walk the talk? Gender representation in World Health Assemblies, 1948-2021

BACKGROUND

While an estimated 70%-75% of the health workforce are women, this is not reflected in the leadership roles of most health organisations-including global decision-making bodies such as the World Health Assembly (WHA).

METHODS

We analysed gender representation in WHA delegations of Member States, Associate Members and Observers (country/territory), using data from 10 944 WHA delegations and 75 815 delegation members over 1948-2021. Delegates' information was extracted from WHO documentation. Likely gender was inferred based on prefixes, pronouns and other gendered language. A gender-to-name algorithm was used as a last resort (4.6%). Time series of 5-year rolling averages of the percentage of women across WHO region, income group and delegate roles are presented. We estimated (%) change ±SE of inferred women delegation members at the WHA per year, and estimated years±SE until gender parity from 2010 to 2019 across regions, income groups, delegate roles and countries. Correlations with these measures were assessed with countries' gender inequality index and two Worldwide Governance indicators.

RESULTS

While upwards trends could be observed in the percentage of women delegates over the past 74 years, men remained over-represented in most WHA delegations. Over 1948-2021, 82.9% of delegations were composed of a majority of men, and no WHA had more than 30% of women Chief Delegates (ranging from 0% to 30%). Wide variation in trends over time could be observed across different geographical regions, income groups and countries. Some countries may take over 100 years to reach gender parity in their WHA delegations, if current estimated trends continue.

CONCLUSION

Despite commitments to gender equality in leadership, women remain gravely under-represented in global health governance. An intersectional approach to representation in global health governance, which prioritises equity in participation beyond gender, can enable transformative policymaking that fosters transparent, accountable and just health systems.

Gender equity in health research publishing in Africa

INTRODUCTION

Women researchers find it more difficult to publish in academic journals than men, an inequity that affects women's careers and was exacerbated during the pandemic, particularly for women in low-income and middle-income countries. We measured publishing by sub-Saharan African (SSA) women in prestigious authorship positions (first or last author, or single author) during the time frame 2014-2016. We also examined policies and practices at journals publishing high rates of women scientists from sub-Saharan Africa, to identify potential structural enablers affecting these women in publishing.

METHODS

The study used Namsor V.2, an application programming interface, to conduct a secondary analysis of a bibliometric database. We also analysed policies and practices of ten journals with the highest number of SSA women publishing in first authorship positions.

RESULTS

Based on regional analyses, the greatest magnitude of authorship inequity is in papers from sub-Saharan Africa, where men comprised 61% of first authors, 65% of last authors and 66% of single authors. Women from South Africa and Nigeria had greater success in publishing than those from other SSA countries, though women represented at least 20% of last authors in 25 SSA countries. The journals that published the most SSA women as prominent authors are journals based in SSA. Journals with overwhelmingly male leadership are also among those publishing the highest number of SSA women.

CONCLUSION

Women scholars in SSA face substantial gender inequities in publishing in prestigious authorship positions in academic journals, though there is a cadre of women research leaders across the region. Journals in SSA are important for local women scholars and the inequities SSA women researchers face are not necessarily attributable to gender discrepancy in journals' editorial leadership.

The influence of an all-female healthcare environment on mentorship and empowerment of female healthcare professionals

Low- and middle-income countries (LMICs) have the greatest need for additional healthcare providers, and women outside the workforce help address the need. Women in healthcare need more mentorship and leadership training to advance their careers due to systemic barriers. This study evaluates how women working together on a medical team influences mentorship, leadership and empowerment. A single all-female volunteer team participating in a cleft surgery mission in Oujda, Morocco were surveyed before and after the mission. Statistical analysis with student's t-test or chi-squared were performed. 95 female volunteers from 23 countries participated on this team and 85% completed surveys. Volunteers from high-income countries (32%) and LMICs (68%) had similar mission roles (p = 0.58). Experience as a mission volunteer (p = 0.47), team leader (p = 0.28), and educator (p = 0.18) were equivalent between cohorts. 73% of women had previously received mentorship but 98% wanted more. 75% had previously mentored others, but 97% wanted to be mentors. 73% of volunteers who had no prior mentorship found their first mentor during the mission. All participants found a long-term peer relationship and felt motivated to mentor women at home. 95% were inspired to pursue leadership positions, advance professionally, and continue working with other women. This population of female healthcare professionals overwhelmingly desired more mentorship than is felt to be available. An all-female healthcare environment appears to provide opportunities for mentorship and create lasting motivation to teach, lead, and advance professionally. Findings raise the potential that increasing visibility of female professionals may effectively empower women in healthcare.

Novel, Low-Cost Intervention to Promote Women's Advancement in Global Health Research

PROBLEM

Women comprise 7 out of every 10 health care workers globally yet are significantly underrepresented in leadership positions. The COVID-19 pandemic has exacerbated underlying gender disparities, placing additional burdens on many female global health professionals.

APPROACH

The authors describe the development of a novel, low-cost pilot program-the Female Global Scholars Program (Weill Cornell Medicine)-established in April 2018 to promote the advancement of female global health research professionals and prepare them for leadership positions in this field. Using a logic model, the program was informed by discussion with peers at scientific symposia, qualitative research examining the barriers women experience in global health, discussions with experts in the fields of global health and medical education, and a literature review of other initiatives focused on fostering female advancement. The program provides opportunities to learn leadership skills and peer mentoring to female junior investigators in global health research over the course of 2 years through attendance of a symposium and skill-building workshop, skill-building webinars, and the building of a peer mentor group.

OUTCOMES

The inaugural cohort of the Female Global Scholars Program (April 2018-March 2020) included 10 female global health researchers from 6 countries (Haiti, India, Kenya, Tanzania, Uganda, and the United States) across 3 continents. By the end of year 1, 6 participants received academic promotions. Additionally, the inaugural 10 scholars collectively presented at 11 international conferences and submitted 22 abstracts and 19 manuscripts.

NEXT STEPS

The authors hope to provide additional support and guidance to scholars as they become leaders of their own versions of this program at their home sites and plan to expand the faculty group to further lessen the time burden, while enabling the program to provide additional research mentorship to scholars.

Institutional-level drivers of gender-inequitable scientific career progression in sub-Saharan Africa

BACKGROUND

This study sought to determine how institutional environments, including values, policies, and their implementation, shape inequities in scientific career progression for women and men, and their disadvantages in relation to their multiple social identities in sub-Saharan Africa (SSA). The findings are drawn from a wider research study that was aimed at gaining an in-depth understanding of the barriers and enablers of gender-equitable scientific career progression for researchers in SSA. This was nested within the context of the Developing Excellence in Leadership, Training and Science in Africa (DELTAS Africa) programme-a health-based scientific research capacity-strengthening initiative.

METHODS

The study adopted an exploratory qualitative cross-sectional study design. In-depth interviews (IDIs) with trainees/research fellows at various career stages supported and/or affiliated to three purposively selected DELTAS Africa Research Consortia were the main method of data collection. In addition, key informant interviews (KIIs) with consortia research leaders/directors, co-investigators, and the consortia management team were also conducted to corroborate information gathered from the IDIs, and also to provide additional insights on the drivers of intersectional gender-inequitable career progression. In total, 58 IDIs (32 female and 26 male) and 20 KIIs (4 female and 16 male) were conducted. The interviews were carried out in English between May and December 2018. The data were analysed inductively based on emergent themes.

RESULTS

Three interrelated themes were identified: first, characterization of the institutional environment as highly complex and competitive with regard to advancement opportunities and funding structure; second, inequitable access to support systems within institutions; third, informal rules-everyday experiences of negative practices and culture at the workplace, characterized by negative stereotypical attitudes, gender biases, sexual harassment, and bullying and intimidation.

CONCLUSIONS

We contend that understanding and addressing the social power relations at the meso-institutional environment and macro-level contexts could benefit career progression of both female and male researchers by improving work culture and practices, resource allocation, and better rules and policies, thus fostering positive avenues for systemic and structural policy changes.

Enablers of gender equitable scientific career progression in Sub-Saharan Africa: Insights from the DELTAS Africa Initiative

Background: This paper present findings on current strategies utilised within selected Developing Excellence in Leadership, Training and Science in Africa’ (DELTAS Africa) consortia to promote gender equitable scientific career progression for researchers, as well as participants’ recommendations for change. Findings are drawn from a wider research study nested within this health-based scientific research capacity strengthening initiative that was aimed at gaining an in-depth understanding of the barriers and enablers of gender equitable scientific career progression for researchers in Sub-Saharan Africa.  Methods: We adopted an exploratory qualitative cross-sectional study design. The main method of data collection was in-depth interviews (IDIs) with trainees/research fellows at various career stages affiliated to three purposively selected DELTAS Africa Research Consortia. In addition, key informant interviews (KIIs) with consortia research leaders/directors, co-investigators, and management team were also conducted to corroborate information gathered from the IDIs, and to provide additional insights on the enabling factors/actions and policy processes that were currently in place or proposed to enhance gender equitable career progression. In total, fifty-eight IDIs (32 female and 26 male) and twenty KIIs (4 female and 16 male) were conducted. Interviews were carried out between May and December 2018 in English. Data were analysed inductively based on emergent themes, and aligned to the developed integrated conceptual framework. Results: Three overarching themes were identified. First: micro level efforts - individual coping mechanisms and familial level support. Second: Meso level efforts -existing enabling mechanisms at the institutional level. Third: proposed solutions for positive change towards enhancing gender equitable career progression at micro, meso and macro levels.  Conclusions: These findings have implications for future research capacity strengthening programming, including DELTAS Africa II initiative (2021-2025); they provide valuable insights on potential strategies and actions aiming to narrow gender inequities in scientific career progression in the context of sub-Saharan African research institutions.

The health literacy of university students in North Cyprus

Health literacy is individuals' motivation and ability to obtain, understand, evaluate and use health information. Health literacy is very important during university education when students have the ability to acquire and accumulate knowledge of the best way. The aim of this study was to determine the health literacy of university students. The sample of this descriptive cross-sectional study was composed of 365 students who were first-time visitors at the health center of a private university in Northern Cyprus between May and July 2017. An introductory information form and the Adult Health Literacy Scale (AHLS) were used as data collection tools. The mean AHLS score of the students was found as 13.91 ± 2.90. Health literacy was found to be lower for male students and students with more years of study. The students with low daily alcohol use had higher AHLS scores. The results of the study suggest that curricula should be revised to raise the health literacy of university students to the highest level. It is important to organize conferences, seminars and scientific activities to improving the health literacy of male students and students with more years of study. Due to the limitations of studies of health literacy in North Cyprus, future studies should be conducted with larger samples and different measurement tools.

"Having more women humanitarian leaders will help transform the humanitarian system": challenges and opportunities for women leaders in conflict and humanitarian health

BACKGROUND

It is estimated that over 40% of the half a million humanitarian workers who provide frontline care during emergencies, wars and disasters, are women. Women are at the forefront of improving health for conflict-affected populations through service delivery, education and capacity strengthening, advocacy and research. Women are also disproportionately affected by conflict and humanitarian emergencies. The growing evidence base demonstrating excess female morbidity and mortality reflects the necessity of evaluating the role of women in leadership driving health research, policy and programmatic interventions in conflict-related humanitarian contexts. Despite global commitments to improving gender equality, the issue of women leaders in conflict and humanitarian health has been given little or no attention. The aim of this paper focuses on three domains: importance, barriers and opportunities for women leaders in conflict and humanitarian health. Following thematic analysis of the material collected, we discuss the following themes: barriers of women's leadership domain at societal level, and organisational level, which is subcategorized into culture and strategy. Building on the available opportunities and initiatives and on inspirational experiences of the limited number of women leaders in this field, recommendations for empowering and supporting women's leadership in conflict health are presented.

METHODS

A desk-based literature review of academic and grey sources was conducted followed by thematic analysis.

RESULTS

There is very limited evidence on women leaders in conflict and humanitarian health. Some data shows that women have leadership skills that help to support more inclusive solutions which are incredibly important in this sector. However, deeply imbedded discrimination against women at the organisational, cultural, social, financial and political levels is exacerbated in conflict which makes it more challenging for women to progress in such settings.

CONCLUSION

Advocating for women leaders in conflict and health in the humanitarian sector, governmental bodies, academia and the global health community is crucial to increasing effective interventions that adequately address the complexity and diversity of humanitarian crises.

An Evaluation of an Experiential Learning Program in Global and Indigenous Health: The University of Manitoba's Queen Elizabeth II Diamond Jubilee Scholarship Program

We conducted a mixed-methods outcome evaluation to examine student experiences and learning in the University of Manitoba’s Queen Elizabeth II Diamond Jubilee Scholarship Program in Global and Indigenous Health. Our scholarship program is a bi-directional, 3-month international experiential learning program, including both undergraduate and graduate students, with associated online course focused on community engagement. Students completed a semi-structured narrative report at the conclusion of their funding related to their experience and learning. The Likert questions were analyzed descriptively and student responses to the open-ended questions were utilized for thematic analysis. Also included in this paper is a summary of our lessons learned through program administration. A total of 38 students completed the program between 2016 and 2018, with 95% reporting that they either met or exceeded their goals in the program. Three overarching and inter-related themes emerged in our thematic-analysis of students’ narrative reports, including success through relationships and new perspectives, challenges of the unfamiliar, and personal growth through strong emotions. Many students reported personal growth as their greatest success and linked this with new perspectives and awareness of how different contexts shaped their understanding of health issues. Overcoming challenges in their placements contributed to students’ confidence in their ability to problem-solve. Overall, students reported value in their experiential learning, which further supports the growing trend to incorporate both experiential learning and formal education in community engagement in public health pedagogy. However, international experiential learning requires considerable financial and human resource commitments to ensure its success.

Gender imbalance in executive management positions at the Mexican National Institutes of Health

BACKGROUND

Around the world, there is a significant difference in the proportion of women with access to leadership in healthcare with respect to men. This article studies gender imbalance and wage gap in managerial, executive, and directive job positions at the Mexican National Institutes of Health.

METHODS

Cohort data were described using a visual circular representation and modeled using a generalized linear model. Analysis of variance was used to assess model significance, and posterior Fisher's least significant differences were analyzed when appropriate.

RESULTS

This study demonstrated that there is a gender imbalance distribution among the hierarchical position at the Mexican National Health Institutes and also exposed that the wage gap exists mainly in the (highest or lowest) ranks in hierarchical order.

CONCLUSIONS

Since the majority of the healthcare workforce is female, Mexican women are still underrepresented in executive and directive management positions at national healthcare organizations.

[Bibliometric analysis of female authorship in original articles in the journal ATENCIÓN PRIMARIA]

OBJECTIVES

To determine the percentage of female authors in original articles published during 2periods, in the journal of Atención Primaria (Primary Care), and to examine the differences between the categories of authorship (first, last author, and co-author) between both periods.

DESIGN

Cross-sectional study.

SETTING

Feminine scientific production published during the periods 2007-2008 and 2017-2018.

PARTICIPANTS

The study was focused on original articles.

MAIN MEASUREMENTS

The following variables were collected in an ad hoc form: gender based on the name of the author, total number of women and men appearing as authors, and order of authorship. Absolute and relative authorship frequencies were calculated, and the χ² test was used to examine the evolution of the percentages by type of authorship and gender.

RESULTS

A total of 108 articles were analysed in 2007-2008, and 100 in 2017-2018. No statistically significant differences were observed between the mean numbers of women authors within and between periods. In 2007-2008 a total of 548 female authors were identified and 540 in 2017-2018, the percentage of female authors was 48.7% and 54.4%, respectively. Only an increase in the percentage of first authors was observed between periods.

CONCLUSIONS

Practically one out of every 2authors of original articles published in the journal Atención Primaria was female. There was also a significant increase in the percentage of female first authors between the 2periods. Nevertheless, and despite the greater number of health workers, the number of latest female authors remain unchanged, which points to the persistence of female under-representation.

Gender equality in global health leadership: Cross-sectional survey of global health graduates

Women comprise two-thirds of the global-health (GH) workforce but are underrepresented in leadership. GH departments are platforms to advance gender equality in GH leadership. Using a survey of graduates from one GH department, we compared women's and men's post-training career agency and GH employment and assessed whether gender gaps in training accounted for gender gaps in career outcomes. Master-of-Public-Health (MPH) and mid-career-fellow alumni since 2010 received a 31-question online survey. Forty-four per cent of MPH alum and 24% of fellows responded. Using logistic regression, we tested gender gaps in training satisfaction, career agency, and GH employment, unadjusted and adjusted for training received. Women (N = 293) reported lower satisfaction with training (M7.6 vs 8.2) and career agency (leadership ability: M6.3 vs 7.4) than men (N = 60). Women more often than men acquired methods-related skills (95% vs 78%), employment recommendations (42% vs 18%), and group membership. Men more often than women acquired leadership training (43% vs 23%), award recommendations (53% vs 17%), and conference support (65% vs 35%). Women and men had similar odds of GH employment. Accounting for confounders and gender-gaps in training eliminated gender gaps in five of six career-agency outcomes. Panel studies of women's and men's career trajectories in GH are needed.

Gender balance in WHO panels for guidelines published from 2008 to 2018

Objective

To assess the gender composition of guideline contributors for all World Health Organization (WHO) guidelines published from 2008 to 2018.

Methods

We searched for guidelines in the WHO Guideline Review Committee database. We extracted data about the guidelines (title, publication year) and individuals participating (name, role, gender). Guideline roles included: member or chair of guideline development group, WHO steering group, external reviewer or methodologist. We used descriptive statistics to analyse gender composition for each role and the proportion of guideline development group members and chairs who were female.

Findings

We included 230 guidelines involving 13 329 individuals: 219 guidelines (95.2%) reported a guideline development group (4912 individuals). More group members were male (2606; 53.1%) than female (2241; 45.5%). The median proportion of female members per guideline was 47.1% (interquartile range: 35.7–56.3). Half of the guidelines (110; 50.2%) had a development group composed of 40.1–60% females and 75 guidelines (34.2%) had ≤ 40% females in the group. From 2016 to 2018, there were some improvements: one quarter of groups were composed of ≤ 40.0% females in 2016 and 2017, and this reduced to 9.1% in 2018. Among 243 group chairs, 145 (59.7%) were male and 96 (39.5%) were female.

Conclusion

Participation on a guideline panel is a prestigious leadership role in global health. The under-representation of women across most WHO guideline roles shows that inequalities persist even where standards and policies call for gender balance. Attention can be shifted to strengthening accountability mechanisms and understanding the root causes of this imbalance.